Canadian Journal of Public Health

, Volume 94, Issue 1, pp 59–63 | Cite as

The Impact of Influenza-associated Respiratory Illnesses on Hospitalizations, Physician Visits, Emergency Room Visits, and Mortality

  • Verena H. Menec
  • Charlyn Black
  • Leonard MacWilliam
  • Fred Y. Aoki


Objectives: Although the increased risk of hospitalization and mortality during influenza seasons has been documented extensively, there is a relative paucity of research on the impact of influenza-related illnesses on other health care use indicators, such as physician use. The purpose of this study was to examine the impact of influenza-associated respiratory illnesses on the Winnipeg health care system, including hospitalizations, physician visits and emergency room visits. Their impact on mortality was also examined.

Methods: Administrative data were used to track health care use and mortality over four influenza seasons (1995–96 to 1998–99). Excess health care use and deaths were calculated by subtracting rates during influenza seasons from those during weeks when influenza viruses were not circulating.

Results: Significant excess hospitalization, physician visit, and emergency room visit rates emerged for influenza and pneumonia, acute respiratory diseases, and chronic lung disease, especially among children and adults aged 65 and over. Considerable excess mortality due to influenza and pneumonia and chronic lung disease among individuals aged 65 and over also emerged, particularly among nursing home residents.

Discussion: Influenza-associated respiratory illnesses have a substantial impact on the health care system. Given the burden of illness among children during influenza seasons, the study further suggests that influenza vaccination might be considered for this age group.


Objectifs: Les risques accrus d’hospitalisation et de mortalité durant la saison grippale sont bien documentés, mais les études sur les incidences des maladies liées à la grippe sur d’autres indicateurs de l’utilisation des soins de santé, comme le recours aux médecins, sont encore relativement rares. On examine ici les incidences des maladies respiratoires associées à la grippe sur le système de soins de santé de Winnipeg (hospitalisations, visites chez le médecin et visites aux salles d’urgence). On examine aussi leurs incidences sur la mortalité.

Méthode: À l’aide de données administratives, on a suivi l’utilisation des soins de santé et la mortalité sur quatre saisons grippales (1995–1996 à 1998–1999). La surutilisation des soins de santé et la surmortalité ont été calculées en soustrayant les taux durant les saisons grippales des taux durant les semaines où les virus de la grippe ne circulaient pas.

Résultats: La grippe, la pneumonie, les maladies respiratoires aiguës et les pneumopathies chroniques ont causé d’importants excédents dans les taux d’hospitalisation et les visites chez le médecin et dans les salles d’urgence, surtout pour les enfants et les adultes de 65 ans et plus. Une importante surmortalité due à la grippe, à la pneumonie et aux pneumopathies a aussi été enregistrée chez les 65 ans et plus, tout particulièrement parmi les pensionnaires de maisons de soins infirmiers.

Débat: Les maladies respiratoires associées à la grippe ont de graves répercussions sur le système de soins de santé. Comme les enfants tombent souvent malades durant la saison grippale, on recommande aussi d’envisager de les vacciner contre la grippe.


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  1. 1.
    Canadian Consensus Conference on Influenza. Can Commun Dis Rep 1993;19:136–47.Google Scholar
  2. 2.
    Statistics Canada. Selected Leading Causes of Death by Sex, Canada, 1995. Ottawa: Statistics Canada, Health Statistics Division, 1997.Google Scholar
  3. 3.
    Glezen W, Couch R. Interpandemic influenza in the Houston area, 1974–76. N Engl J Med 1978;298:587–92.CrossRefGoogle Scholar
  4. 4.
    Tillett HE, Smith JW, Clifford RE. Excess morbidity and mortality associated with influenza in England and Wales. Lancet 1980;1:793–95.CrossRefGoogle Scholar
  5. 5.
    Barker WH, Mullooly JP. Pneumonia and influenza deaths during epidemics. Arch Intern Med 1982;142:85–89.CrossRefGoogle Scholar
  6. 6.
    Choi K, Thacker SB. Mortality during influenza epidemics in the United States, 1967–1978. Am J Public Health 1982;72:1280–83.CrossRefGoogle Scholar
  7. 7.
    Glezen PW. Serious morbidity and mortality associated with influenza epidemics. Epidemiol Rev 1982;4:24–44.CrossRefGoogle Scholar
  8. 8.
    Perrotta DM, Decker M, Glezen WP. Acute respiratory disease hospitalization as a measure of impact of epidemic influenza. Am J Epidemiol 1985;122:468–76.CrossRefGoogle Scholar
  9. 9.
    Barker WH. Excess pneumonia and influenza associated hospitalization during influenza epidemics in the Unites States, 1970–78. Am J Public Health 1986;76:761–65.CrossRefGoogle Scholar
  10. 10.
    Lui K, Kendal AP. Impact of influenza epidemics on mortality in the United States from October 1972 to May 1985. Am J Public Health 1987;77:712–16.CrossRefGoogle Scholar
  11. 11.
    McBean AM, Babish JD, Warren JL. The impact and cost of influenza in the elderly. Arch Intern Med 1993;153:2105–11.CrossRefGoogle Scholar
  12. 12.
    Glezen WP. Epidemic influenza. Epidemiol Rev 1996;18:64–76.CrossRefGoogle Scholar
  13. 13.
    Baltussen RM, Reinders A, Sprenger MJW, Postma MJ, Jager JC, Ament AJ, et al. Estimating influenza-related hospitalization in the Netherlands. Epidemiol Infect 1998;121:129–38.CrossRefGoogle Scholar
  14. 14.
    Neuzil KM, Reed GW, Mitchell EF, Griffin MR. Influenza-associated morbidity and mortality in young and middle-aged women. JAMA 1999;281:901–7.CrossRefGoogle Scholar
  15. 15.
    Upshur REG, Knight K, Goel V. Time-series analysis of the relation between influenza virus and hospital admissions of the elderly in Ontario, Canada, for pneumonia, chronic lung disease, and congestive heart failure. Am J Epidemiol 1999;149:85–92.CrossRefGoogle Scholar
  16. 16.
    Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis RL, DeStefano F, et al. Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med 2000;342:232–39.CrossRefGoogle Scholar
  17. 17.
    Neuzil KM, Mellen BG, Wright PF, Mitchell EF, Griffin MR. The effect of influenza on hospitaliza-tions, outpatient visits and courses of antibiotics in children. N Engl J Med 2000;342:225–31.CrossRefGoogle Scholar
  18. 18.
    Simonson L, Fukuda K. The impact of influenza epidemics on hospitalizations. J Infect Dis 2000;181:831–37.CrossRefGoogle Scholar
  19. 19.
    Upshur REG, Goel V. Measuring the impact of influenza on the hospital admission rates of the elderly in Ontario: A five-year admission rate analysis, 1988–1993. Can J Public Health 2000;91:144–47.PubMedGoogle Scholar
  20. 20.
    Fleming DM, Zambon M, Bartelds AIM. Population estimates of persons presenting to general practitioners with influenza-like illness, 1987-96: A study of the demography of influenza-like illness in sentinel practice networks in England and Wales, and in the Netherlands. Epidemiol Infect 2000;124:245–53.CrossRefGoogle Scholar
  21. 21.
    Nichol KL, Margolis KL, Wuorenma J, von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994;331:778–84.CrossRefGoogle Scholar
  22. 22.
    Nichol KL, Wourenma J, von Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med 1998;158:1769–76.CrossRefGoogle Scholar
  23. 23.
    Barer ML, Sheps SB, Mustard C, Kasian P. Emergency Room Use in Winnipeg Hospitals, 1991-92. Winnipeg: Manitoba Health, 1994.Google Scholar
  24. 24.
    Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandowski RA. The efficacy of influenza vaccine in elderly persons: A meta-analysis and review of the literature. Ann Intern Med 1995;123:518–27.CrossRefGoogle Scholar
  25. 25.
    National Advisory Committee on Immunization. Statement on influenza vaccination for the 1999–2000 season. Can Commun Dis Rep 1999;25:1–13.Google Scholar
  26. 26.
    Manitoba Health. Manitoba’s Health Indicators Report. Winnipeg: Manitoba Health, 2002.Google Scholar

Copyright information

© The Canadian Public Health Association 2003

Authors and Affiliations

  • Verena H. Menec
    • 1
    • 2
  • Charlyn Black
    • 1
    • 2
  • Leonard MacWilliam
    • 1
    • 2
  • Fred Y. Aoki
    • 3
  1. 1.Department of Community Health SciencesUniversity of ManitobaWinnipegCanada
  2. 2.Manitoba Centre for Health PolicyUniversity of ManitobaWinnipegCanada
  3. 3.Department of MedicineUniversity of ManitobaWinnipegCanada

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